Bibliography of Dutch Famine of 1944  also known as the Hunger Winter

Official food rations were below 1000 calories (4200 J) per person per day from January through April 1945. Pregnant women were allocated some additional food rations, but the extent to which redistribution of these additional rations occurred within families is not known. The famine ceased immediately with liberation in May  1945, when Allied food supplies became abundant.
1.  Hart, Nicky. Famine, maternal nutrition and infant mortality: a re-examination of the Dutch Hunger Winter. Population Studies, Vol. 47, No. 1, Mar 1993. 27-46 pp.
    "During the Dutch Hunger Winter (1945), a unique, documented example of mass famine in an industrialized population, total reproductive loss (fetal and infant mortality) among most exposed mothers remained relatively low. This is explained by highly favourable fetal mortality and unfavourable infant  mortality. The author traces the pattern of low fetal mortality to the higher levels of 'embodied health status' of famine mothers. The high infant mortality of the famine area testifies to the severity of the food and fuel shortage, yet another factor held down the rate of stillbirth. This other factor, it is argued, has a socio-economic character, it is the intrinsic 'embodied' nutritional status of the regional population, arising from favourable opportunities for growth and development among successive generations of mothers.
This explanation highlights the importance of maternal vitality, (a synthetic, historically variable and culturally determined phenomenon) as a neglected feature of historical demography."

2.  A C J Ravelli; J H P van der Meulen; R P J  Michels; C Osmond; et al.  Glucose tolerance in adults after prenatal exposure to famine The Lancet Jan 17, 1998; Vol. 351, Iss.         9097, p.173-177  Full text available if you are logged on to an HKUST server.
Ravelli et al conclude that prenatal exposure to famine, especially during late gestation, is linked to decreased glucose tolerance in adults.

3. Lumey, L.H. Aryeh D Stein. In utero exposure to famine and subsequent fertility: The Dutch
famine birth cohort study. American Journal of Public Health  vol. 87, iss. 12 Dec 1997, p. 1962-1966
A study hypothesized that if prenatal caloric restriction due to nutritional deprivation had affected development of the organs responsible for producing and regulating female reproductive hormones, a woman's fertility would be impaired. Acute famine exposure in utero appears to have no adverse consequences for a woman's fertility.
We hypothesized that if prenatal caloric restriction due to nutritional deprivation had affected  development of the organs responsible for producing and regulating female reproductive hormones, a woman's fertility would be impaired.

Women born in Amsterdam from August 1, 1944, through April 15, 1946, a period encompassing a  severe 5-month famine, were identified (n = 700; 85% response rate). Date of birth and vital status of all  offspring were aed by home interview between 1987 and 1991. Famine exposure was inferred from the mother's date of birth.

Of the study participants, 74 (10.6%) had no children. The remainder reported 1334 offspring (1294  singletons, 20 pairs of twins), of whom 14 were stillborn and 22 died in the first 7 days of life. There was no  detectable effect of famine exposure on age at menarche, the proportion having no children, age at first delivery, or family size. An excess of perinatal deaths occurred among offspring of famine exposed women, particularly  those exposed in their third trimester.

Acute famine exposure in utero appears to have no adverse consequences for a woman's fertility. The excess perinatal mortality in the second generation is unexplained and should be confirmed by other studies.

4. Neugebauer, Richard; Hoek, Hans Wijbrand Hoek; Susser, Ezra. Prenatal exposure to wartime famine and development of antisocial personality disorder in early adulthood  JAMA (The Journal of the American Medical Association ), v. 282, Iss. 5 (Aug 4, 1999) p. 455-462.
Dutch men born in 1994-1946 who were given psychiatric examinations for military induction at  age 18 were studied in terms of their prenatal exposure to nutritional deficiency to determine what correlation might exist between antisocial personality disorder (ASPD) and prenatal nutritional deficiency. The results are presented.

5. Stein, Aryeh D; Ravelli, Anita C J; Lumey, L H.Famine, third-trimester pregnancy weight gain, and intrauterine growth: The Dutch famine birth cohort study. Human Biology v. 67, iss. 1 (Feb. 1995) p. 135-
In a study, data from the Dutch Famine Birth Cohort Study were analyzed to determine the influence of acute famine on the relation of maternal weight gain to birth weight, length and ponderal index.

Discussion :
Infant survival is directly related to birth weight. Our data suggest cumulative
effects of severe nutritional deprivation during pregnancy on birth size, which may
be trimester specific. When weight gain is adequate, there is no relation between
weight gain and birth size. Once weight gain drops below 0.5 kg/week, however,
further reductions in weight gain are accompanied by reduced birth weight, length,
and ponderal index. Our exploratory analysis by cohort of exposure suggests that
the effects of famine on the relation between weight gain and birth size are trimester
specific, but this analysis is limited by the small sample sizes of the exposed

It is not clear whether famine-induced reduced length and ponderal index at birth
are maintained throughout life if food supplies are not restricted in childhood.
Preliminary data from follow-up of survivors of the present cohort show
persistence of the period effects on weight (but not height) through age 18 years
(Lumey et al. 1992). Among males subjected to in utero famine exposure and
examined at age 18 years, mid-pregnancy exposure was associated with reduced
body mass index, whereas an increased prevalence of obesity was observed among
males exposed in the first trimester (Ravelli et al. 1976). These data, although
population based, are limited to survivors, and birth length and weight data were not
available. Differential survival may be an important intermediate factor; among
births in our series (including those excluded from the present analysis) perinatal
and infant mortality exceeded 12% and mean birth weight was 500 g lower among
nonsurvivors than among survivors (Lumey et al. 1993).

In conclusion, nutritional deprivation severe enough to result in maternal weight loss or reduced weight gain results in a corresponding reduction in offspring length and ponderal index (and hence also birth weight). The relationship between maternal weight gain and infant birth size also holds in the nonfamine situation when weight gain is low. However, when weight gain is high (over 0.5 kg/week in this data set), no further increments in offspring birth size were observed with additional maternal weight gain. Our results affirm the hypothesis proposed by Susser (1991) that maternal nutritional deprivation affects fetal growth only below a threshold and that, conversely, even after a famine period offspring birth size does not respond in a  linear fashion to ad libitum maternal feeding during the rehabilitation period. Further research is required to identify more precisely key periods of risk for the fetus.

Literature Cited:
Chambers, J.M., W.S. Cleveland, B. Kleiner et al. 1983. Graphical Methods for Data Analysis. Boston, MA: Wadsworth International Group.

Crane, J.P., and M.M. Kopta. 1980. Comparative newborn anthropometric data in  symmetric versus asymmetric intrauterine growth retardation. Am. J. Obstet.Gynecol. 138:518-522.

Institute of Medicine. 1990. Nutrition during Pregnancy, Part 1, Weight Gain. Washington, DC: National Academy Press.

Kramer, M.S., M. Olivier, F.H. McLean et al. 1990. Determinants of fetal growth  and body proportionality. Pediatrics 86:18-26.

Lawton, F.G., G.C. Mason, K.A. Kelly et al. 1988. Poor maternal weight gain  between 28 and 32 weeks gestation may predict small-for-gestational-age infants.Br. J. Obstet. Gynecol. 95:884-887.

Lumey, L.H., A.C.J. Ravelli, L.G. Wiessing et al. 1993. The Dutch Famine Birth  Cohort Study: Design, validation of exposure, and selected characteristics of subjects after 43 years follow-up. Pediatr. Perinatal Epidemiol. 7:354-367.

Lumey, L.H., G.A. Stam, A.C.J. Ravelli et al. 1992. Birth weight, birth cohort, and  adult weight among women born during the Dutch famine of 1944-45. Am. J Epidemiol. 136:951-952.

Miller, H.C., K. Hassanein, and P.A. Hensleigh. 1976. Fetal growth retardation in  relation to maternal smoking and weight gain in pregnancy. Am. J. Obstet. Gynecol.125:55-60.

Mitchell, M.C., and E. Lerner. 1989. Weight gain and pregnancy outcome in  underweight and normal weight women. J. Am. Dietet. Assoc. 89:634-641.

Neter, J., W. Wasserman, and M.H. Kutner. 1983. Applied Linear Regression  Models. Homewood, IL: Richard D. Irwin.

Pebley, A.R., S.L. Huffman, A.K.M.A. Chowdhury et al. 1985. Intrauterine  mortality and maternal nutritional status in rural Bangladesh. Popul. Stud. 39:425-440.

Ravelli, G., Z.A. Stein, and M.W. Susser. 1976. Obesity in young men after famine  exposure in utero and early infancy. New Engl. J. Med. 295:349-353.

Sindram, I.S. 1953. De involved van ondervoeding op de groei van de vrucht [The  influence of undernutrition on the growth of the fetus]. Ned. Tijdschr. Verloskde. Gynecol. 45:30-48.

Smith, C.A. 1947. Effects of wartime starvation in Holland on pregnancy and its  products. Am. J. Obstet. Gynecol. 53:599-608.

Stein, Z., M. Susser, G. Saenger et al. 1975. Famine and Human Development: The  Dutch Hunger Winter of 1944/45. New York: Oxford University Press.

Susser, M. 1991. Maternal weight gain, infant birthweight, and diet: Causal  sequences. Am. J. Clin. Nutr. 53:1384-1396.

Trienekens, G.M.T. 1985. Tussens ons volk en de honger. De voedselvoorziening  1940-1945 [Between our people and the famine: The food distribution system,1940-1945]. Utrecht, Netherlands: Matrijs.

Villar, J., and J.M. Belizan. 1982. The timing factor in the pathophysiology of the  intrauterine growth retardation syndrome. Obster. Gynecol. Surv. 37:499-506.

Woods, D.L., A.F. Malan, and H. de V. Heese. 1979. Patterns of retarded fetal  growth. Early Hum. Dev. 3:257-262.

6. Timing in prenatal nutrition: A reprise of the Dutch famine
Nutrition Reviews, v. 52, Iss. 3, p. 84- (Mar 1994).

Interest in prenatal nutrition as a subject of serious scientific study has fluctuated during the past 100 years. The study of the Dutch famine of 1944-45 is examined to illustrate the point that the effects of prenatal nutrition are obscured if the nutritional exposure is not closely defined in terms of developmental timing.

Literature cited:

1. Susser M. Disease, illness, sickness: impairment, disability and handicap. [Guest Editorial] Psychol Med 1990;20:471-3

2. Ebbs JH, Tisdall FF, Scott WA. The influence of prenatal diet on the mother and child. J Nutr 1941;22:515-26

3. Burke BS, Harding VV, Stuart HC, Nutrition studies during pregnancy. IV. Relation of protein content of mother's diet during pregnancy to birth length, birth weight and condition of infant at birth. J Pediatr 1943;23:506-15

4. Cameron CS, Graham S. Antenatal diet and its influence on stillbirths and prematurity. Glasgow Med J 1944;142:1-7

5. Baird D. Epidemiologic patterns over time. In: Reed DM, Stanley FJ, eds. The epidemiology of prematurity. Baltimore/Munich: Urban, Schwarzenberg, 1977:5-15

6. Antonov AN. Children born during the siege of Leningrad in 1942. J Pediatr 1947;30:250-9

7. Sindram IS. De invloed van ondervoeding op de groei van de vrucht. Ned Tijdschr Verlosk 1945;45:30-48

8. Smith CA. Effects of wartime starvation in Holland on pregnancy and its products. Am J Obstet Gynecol 1947;53:599-608

9. McCance RA, Widdowson EM, Dean RFA, Thrussell LA. Studies on undernutrition, Wuppertal 1946-9. Medical Research Council Special Report Series No. 275, London, His Majesty's Stationery Office, 1951

10. Tompkins WT, Mitchell R McN, Wiehl DG. Maternal and newborn nutrition  studies at Philadelphia lying-in-hospital. Maternal studies II. Prematurity and maternal nutrition. The promotion of maternal and newborn health. New York: Milbank Memorial Fund, 1955

11. Derby WJ, Densen PM, Cannon RO, et al. The Vanderbilt cooperative study of  maternal and infant nutrition. I Background. II. Methods. III. Description of the sample and data. J Nutr 1953;51:539-63

12. McGanity WJ, Cannon RO, Bridgforth EB, et al. The Vanderbilt cooperative study of maternal and infant nutrition. V. Description and outcome of obstetrics sample. Am J Obstet Gynecol 1954;67:491-500

13. Thomson AM. Diet in pregnancy 1. Dietary survey technique. Br J Nutr  1958;12:446-61

14. Thomson AM. 3. Diet in relation to the course and outcome of pregnancy. Br J Nutr 1959;13:509-25

15. Stockard CR. Developmental rate and structural expression: an experimental  study of twins, "double monsters," and single deformities and the interaction among embryonic organs during their origin and development. Am J Anat 1921;28:115-277

16. McCance RA. Food, growth and time. Lancet 1962;ii:621-6, 671-5

17. McCance RA, Widdowson EM. Review lecture: the determinants of growth and form. Proc R Soc Lond (Biol) 1974;185:1-17

18. Dobbing J. The influence of early nutrition on the development and myelination of the brain. Proc R Soc (Biol) 1964;153:503-9

19. Winick M, Noble A. Cellular response in rats during malnutrition at various ages. J Nutr 1966;89:300-6

20. Zamenhoff S, van Marthens E, Margolis FL. DNA (cell number) and protein in  neonatal brain: alteration by maternal dietary protein restriction. Science 1968;160:322-3

21. Davison AN, Dobbing J. Myelinization as a vulnerable period in brain development. Br Med Bull 1966;22:40-4

22. Stein Z, Susser M. Effects of early nutrition on neurological and mental competence in human beings. Psychol Med 1985;15:717-26

23. Scrimshaw NS, Taylor CE, Gordon JE. Interactions of nutrition and infection. World Health Organization Monograph No. 57, 1968

24. Mora JD, de Paredes B, Wagner M, et al. Nutritional supplementation and the outcome of pregnancy. I. Birthweight. Am J Clin Nutr 1979;32:455-62

25. Rush D, Stein Z, Susser M. Diet in pregnancy: a randomized controlled trial of  prenatal nutritional supplements. Birth defects: original article series. New York: Alan R. Liss, 1980:16

26. Bergner L, Susser MW. Low birthweight and prenatal nutrition: an interpretive review. Pediatrics 1970;46:946-66

27. Stein Z, Susser M, Saenger G, Marolla F. Famine and human development: the  Dutch Hunger Winter of 1944/45. New York: Oxford University Press, 1975

28. Susser M: What is a cause and how do we know one? A grammar for pragmatic epidemiology. Am J Epidemiol 1991;133:635-48

29. Stein Z, Susser MW, Saenger G, Marolla F. Nutrition and mental performance. Science 1972;178:708-13

30. Lumey LH, Ravelli ACH, Wiessing LG, et al. The Dutch famine birth cohort  study: design, validation of exposure, and selected characteristics of subjects after 43 years follow-up. Paediatr Perinat Epidemiol 1993;7:354-67

31. Susser M: Maternal weight gain, birth weight and diet: causal sequences. Am J Clin Nutr 1991;53:1384-96

32. Stein AD, Ravelli ACJ, Lumey LH. Famine exposure and intrauterine growth  retardation: the Dutch famine birth cohort study. [Abstract] Am J Epidemiol 1993;138:657

33. Ravelli GP, Stein ZA, Susser MW. Obesity in young men after famine exposure  in utero and early infancy. N Engl J Med 1976;295:349-53

34. Jones AP, Friedman MI. Obesity and adipocyte abnormaltries in offspring of  rats undernourished during pregnancy. Science 1982;219:1093-4

35. Enns MP, Wilson MW, Grinker JA, Faust IM. Prenatal food restriction and subsequent weight gain in male rats. Science 1983;219:1093-4

36. Jones AP, Friedman MI. Reply to Enns et al. Science 1983;219:1094

37. Lumey LH, Stam GA, Ravelli AC, Stein ZA. Birth weight, birth cohort and adult weight among women born during the Dutch famine of 1944-45. [Abstract] Am J Epidemiol 1992;136:951

38. Belmont L, Marolla FA. Birth order, family size and intelligence. Science 1973;182:1096-101

39. Belmont L, Stein Z, Susser M. A comparison of the associations of birth order with intelligence test score and with height. Nature 1975;255:54-6

40. Susser E. Schizophrenia after prenatal exposure to the Dutch Hunger Winter of 1944/45. Arch Gen Psychiatry 1992;49:983-8

41. Susser E, et al. a. submitted

42. Susser E, et al. b. submitted

43. Klebanoff MA, Yip R. Influence of maternal birth weight on rate of fetal growth and duration of gestation. J Pediatr 1987;111:287-92

44. Emanuel I, Filakti H, Alberman E, Evans SJW. Intergenerational studies of  human birthweight from the 1958 birth cohort. 1. Evidence for a multigenerational effect. Br J Obs Gynecol 1992;99:67-74

45. Alberman E, Emanuel I, Filakti J, Evans SJW. The contrasting effects of parental birthweight and gestational age on the birthweight of offspring. Paediatr Perinat Epidemiol 1992;6:143-4

46. Lumey LH. Decreased birthweights in infants after maternal in utero exposure to the Dutch famine of 1944-45. Paediatr Perinat Epidemiol 1992;6:240-53

47. Lumey LH, Stam GA, Ravelli ACJ, Santana SM, Stein Z. Birth cohort, birthweight and offspring birthweight of women born during the Dutch famine of 1944-1945. [Abstract] Paediatr Perinat Epidemiol 1993;7:A3-4

6. The Independent (London)  October 25, 1999, Monday  Pg. 7.
 Malnourished Mothers Breed Obese Daughters.(Byline: Steve Connor Science Editor)
"WOMEN WHOSE mothers were malnourished during the early stages of pregnancy stand a greater chance of becoming overweight in middle age. A study of women who were pregnant during the Dutch  famine of 1944-45 found that their daughters were significantly more obese at the age of 50....

"Other findings of the Dutch study show that the children of women who were pregnant during the famine  are more likely to develop late-onset diabetes, resulting in an imbalance of blood sugars."

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